| Ellison Center | |
|
600 25th Ave S Ste 102 Saint Cloud MN 56301-4820 | |
| (320) 406-1600 | |
| (320) 406-1700 |
| Full Name | Ellison Center |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 600 25th Ave S Ste 102, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Theresa J Schreifels (THERAPIST) |
| Authorized Official Contact | 3204061600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellison Center 600 25th Ave S Ste 102 Saint Cloud MN 56301-4820 Ph: (320) 406-1600 | Ellison Center 600 25th Ave S Ste 102 Saint Cloud MN 56301-4820 Ph: (320) 406-1600 |
| NPI Number | 1740744242 |
|---|---|
| Provider Enumeration Date | 01/29/2019 |
| Last Update Date | 11/05/2020 |
| Certification Date | 11/05/2020 |
| Medicare PECOS PAC ID | 4688080989 |
|---|---|
| Medicare Enrollment ID | O20210311001264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740744242 | NPI | - | NPPES |
| 1740744242 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Alison Marie Erickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952933715 PECOS PAC ID: 6800223389 Enrollment ID: I20200221001665 |
| Provider Name | Anna Clavin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366892366 PECOS PAC ID: 8628417193 Enrollment ID: I20240416003960 |
| Provider Name | Theresa J Schreifels |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720327364 PECOS PAC ID: 0941616247 Enrollment ID: I20240422000363 |
| Provider Name | Heather K Trettel |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902227580 PECOS PAC ID: 3971942178 Enrollment ID: I20240422000495 |
| Provider Name | Pamela Walz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336690023 PECOS PAC ID: 1951742311 Enrollment ID: I20240516000584 |
| Provider Name | Shelby E Lies |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922629575 PECOS PAC ID: 7911449947 Enrollment ID: I20240606000229 |
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